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  • 1
    Online Resource
    Online Resource
    BMJ ; 2022
    In:  Journal of Neurology, Neurosurgery & Psychiatry Vol. 93, No. 6 ( 2022-06), p. A62.1-A62
    In: Journal of Neurology, Neurosurgery & Psychiatry, BMJ, Vol. 93, No. 6 ( 2022-06), p. A62.1-A62
    Abstract: To assess the impact of a national atraumatic lumbar puncture needle campaign on lumbar puncture needle usage across the United Kingdom. The campaign commenced in 2015, to increase usage of atraumatic needles to reduce complications associated with traumatic needles. Design Retrospective cross-sectional audit Methods We requested procurement orders from all regional neuroscience centres in the United Kingdom, through freedom of information (FOI) requests to identify their lumbar puncture needle purchases over a four-year period (2015–2018). Of all sites, 20 centres provided usable datasets. Product codes were cross correlated to identify the type of lumbar puncture needle used. The procurement orders were used as a surrogate marker for lumbar puncture needle usage and to calculate a ratio of atraumatic: traumatic needles. Results In total we analysed 739,209 procurement orders over the four-year period. The Atraumatic/Traumatic needle ratio was 0.244 ± 0.039 in 2015 and increased to 0.276 ± 0.046 in 2016 (p=0.05), with a subsequent decrease in 2017 to 0.252 ±0.042 (p=0.37) and 2018 to 0.256 ± 0.037 (p=0.93). Conclusions Despite the increase between 2015 and 2016, the impact of the atraumatic lumbar puncture needle campaign has been marginal. Further efforts will be needed to effect a change in the ‘needle culture’ across neuroscience centres. Aside from the campaigning to highlight reduced complications and the cost-effectiveness of atraumatic needles, further initiatives such as a Delphi process should be considered. gideon adegboyega@gmail.com 117
    Type of Medium: Online Resource
    ISSN: 0022-3050 , 1468-330X
    RVK:
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 1480429-3
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  • 2
    Online Resource
    Online Resource
    BMJ ; 2022
    In:  Journal of Neurology, Neurosurgery & Psychiatry Vol. 93, No. 6 ( 2022-06), p. A64.2-A64
    In: Journal of Neurology, Neurosurgery & Psychiatry, BMJ, Vol. 93, No. 6 ( 2022-06), p. A64.2-A64
    Abstract: To assess the impact of the usage of atraumatic lumbar puncture needles on lumbar puncture complications across the United Kingdom, following the national atraumatic lumbar puncture needle campaign which commenced in 2015 Design A retrospective cross-sectional audit of regional datasets was employed. Subjects All patients undergoing a lumbar puncture for both therapeutic and diagnostic purposes at regional neuroscience centres. Methods We requested hospital episode statistics (HES) from all regional neuroscience centres in the United Kingdom (32 sites). Through freedom of information (FOI) requests we asked the centres to provide the number of epidural blood patches procedures, post-lumbar puncture headaches and lumbar puncture needle procurement orders over a four-year period (2015–2018). A surrogate complication rate was cal- culated by the sum of the complications divided by the total procurement orders. Results Of all sites 32 sites, 16 centres provided usable datasets. Between the period of 2015–2018 there was a non-significant decrease in complication rates when using atraumatic lumbar puncture needles (p=0.14). Conclusions The study did not show a statistically significant decrease in the complication rates over the specified period, supported by previous work suggesting poor adherence to atraumatic needle usage. ines-alsousa@hotmail.com
    Type of Medium: Online Resource
    ISSN: 0022-3050 , 1468-330X
    RVK:
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 1480429-3
    Location Call Number Limitation Availability
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  • 3
    In: Journal for ImmunoTherapy of Cancer, BMJ, Vol. 8, No. 2 ( 2020-09), p. e001294-
    Abstract: Cytotoxic CD8 + T cell-mediated response is the most important arm of adaptive immunity, which dictates the capacity of the host immune response in eradicating tumor cells. Due to tumor intrinsic and/or extrinsic factors, the density and function of CD8 + tumor-infiltrating lymphocytes (TILs) could be compromised, leading to poor prognosis and survival. Methods Using RNA-Seq, transcriptomes of sorted CD3 + CD8 + TILs from treatment-naïve colorectal cancer (CRC) patients at advanced stages (III and IV) were compared with those from patients with early stages (I and II). A signature referred to as ‘poor prognosis CD8 gene signature (ppCD8sig)’ was identified and analyzed in The Cancer Genome Atlas CRC dataset. Scores for the ppCD8sig were calculated and classified as high, intermediate and low, and its prognostic significance was assessed using multivariate analysis and Cox proportional hazard model. Densities of CD3 + and CD8 + T cell infiltration in tumors from patients with high and low ppCD8sig scores were assessed by flow cytometry and immunostaining. Results Genes related to epigenetic regulation and response to hypoxia were upregulated in CD8 + TILs from patients with advanced stages, while genes related to T cell activation, cell proliferation and cell cycle were downregulated. Patients with high ppCD8sig score had poorer disease-specific survival (DSS) and shorter progression-free interval (PFI). The ppCD8sig was an independent prognostic indicator for DSS (HR 1.83, 95% CI 1.40 to 2.38, p 〈 0.0001) and PFI (HR 1.42, 95% CI 1.04 to 1.93, p=0.026). Additionally, patients with high ppCD8sig score were more likely to have advanced stages (χ 2 p 〈 0.0001) and residual disease after primary therapy (χ 2 p=0.046). Patients with high ppCD8sig score had reduced levels of CD3 + and CD8 + TILs and low Immunoscores (IS), compared to patients with low ppCD8sig score. Conclusions Our data provided insights into the altered regulation of biological mechanisms and signaling pathways in CD8 + TILs during CRC progression, and revealed a gene signature as an independent prognostic indicator. Patients with high ppCD8sig score had lower levels of TILs and low IS. These data further confirm the prognostic value of the identified ppCD8sig and potentially highlight its clinical relevance.
    Type of Medium: Online Resource
    ISSN: 2051-1426
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2719863-7
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